Inside the South African Government's Controversial AIDS Panel

The other proposed study was more a sharing of data. Some dissidents, such as Bialy and Rasnick, had theorized that HIV is a harmless "passenger virus" that is inherited at birth and causes no disease. To test this hypothesis, they proposed a telephone survey of people who had been rejected in the 1980s from enlisting in the American army as a result of testing HIV-positive. If the vast majority were still alive, then that would suggest that HIV is harmless.

Aside from the fact that there are no records tracing such people, there are much simpler ways to determine whether HIV is deadly. Researchers at Chris Hani Baragwanath hospital in Soweto followed children born to HIV-positive mothers and found that infected babies had a death rate more than 19 times higher than uninfected babies. The CDC has provided the dissidents with its vast data on children born to infected mothers, which also shows that babies with HIV have a higher death rate than those without the virus.

But the dissidents claim that HIV might not be what is killing the babies; for example, they argue that the AIDS drug AZT can cause AIDS diseases. And so, holding the CDC data in his hand, Duesberg asked Gayle whether the babies with HIV had received AZT. Gayle started to answer, but Bialy cut in, saying yes, the babies had received the drug. Duesberg then shouted that AZT was what probably killed the babies, and, as Gayle kept trying to answer his original question, Duesberg stormed out of the room. Eventually, Gayle explained that some of the babies had received the drug while others hadn't, and that the CDC was preparing a breakdown for the dissidents to analyze.

And so it went. Makgoba asked the dissidents to come up with an explanation better than AIDS for the grotesque spike in deaths among young adults. Rasnick tried, saying it was simply because the apartheid government had kept poor records of black people and so "we're now seeing what's been going on for the last 20 or 30 years." But that wouldn't explain why young people are dying more than the elderly, nor why young people are dying at rates that continue to increase even as the new South Africa improves access
to clean water and decent housing. Nor would it explain the similar rise in deaths among young people in neighboring Botswana, which has had a stable and relatively prosperous democracy for more than 30 years.

Some dissidents, such as Duesberg, suggested a toxin or a lack of nutrients might be causing the increase in deaths, but they were unable to specify what exactly the toxin or nutrient deficiency might be in Africa, nor why it should strike mainly young adults while sparing those who are traditionally the most vulnerable to malnutrition, the very young and the very old. Duesberg also argued HIV cannot cause AIDS, because a single virus causes only limited, specific symptoms whereas AIDS comprises many diseases. In fact, HIV is exquisitely specific; it destroys the immune system, leaving the body unable to defend against numerous microbes, which in turn cause the many symptoms of AIDS.

But beyond an explanation, asked South African panelist Salim Abdool-Karim, "what are the positive recommendations" the dissidents would make to curtail the problem? Here, at least, there was some common ground, because dissidents and mainstream panelists alike favor the apple-pie goals of alleviating poverty and improving basic health care. But most of the dissidents argued against providing anti-HIV drugs, which they claim are so toxic that they do more harm than good, despite evidence from all over the world that they reduce AIDS-related death and disease.

What will the panel's convener, President Mbeki, conclude from all this? Just before his panel met, more than 5,000 scientists released a declaration stating why they know HIV causes AIDS. The president's office was reportedly furious, fearing that it presaged a bashing of Mbeki by the huge International AIDS Conference, set to open on July 9 in the South African city of Durban.

Yet there are also signs that Mbeki is realizing that the fundamental dissident tenets will not help his country. His ministry of health recently launched a new five-year plan to combat AIDS that stresses such mainstream tactics as safer sex, and South Africa continues to invest in developing an HIV vaccine. According to Seth Berkley, president of the International AIDS Vaccine Initiative, Mbeki recently stated in public that he believes HIV causes AIDS and that the main problem is treatment. Mbeki has also pointed out that even if the price of anti-HIV drugs fell by half, providing them for all his infected citizens would consume South Africa's entire health budget.

This Sunday, just before the huge International AIDS Conference opens, the price of drugs will be catapulted into the headlines by a large protest march. Immediately after that march, Mbeki will step to the podium to deliver the opening address of the conference. What will he say? Will he endorse the recommendations of those who deny that an epidemic even exists? Almost certainly not. But will he throw his full weight behind what the overwhelming body of scientific evidence shows? Will he face reality?